Healthcare Provider Details

I. General information

NPI: 1619105483
Provider Name (Legal Business Name): CHIOMA OKAFOR-MBAH GOMEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHIOMA OKAFOR-MBAH

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 WESTCHESTER AVE
BRONX NY
10461-4509
US

IV. Provider business mailing address

3251 WESTCHESTER AVE
BRONX NY
10461-4509
US

V. Phone/Fax

Practice location:
  • Phone: 718-792-7600
  • Fax: 718-239-0182
Mailing address:
  • Phone: 718-792-7600
  • Fax: 718-239-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number266343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: